Methods of Abortion

METHODS USED PRIOR TO FOURTEEN WEEKSMETHODS USED PRIOR TO FOURTEEN WEEKS

Early Non-Surgical Abortion

  • A drug is given that stops the hormones needed for the fetus to grow. In addition, it causes the placenta to separate from the uterus, ending the pregnancy
  • A second drug is given by mouth or placed in the vagina causing the uterus to contract and expel the fetus and placenta.
  • A return visit to the doctor is required for follow up to make sure the abortion is completed.

Possible risks

  • Incomplete abortion
  • Allergic reaction to the medications
  • Painful cramping
  • Nausea and/or vomiting
  • Diarrhea
  • Fever
  • Infection
  • Heavy bleeding

Vacuum Aspiration Abortion

  • A local anesthetic is applied or injected into or near the cervix to prevent discomfort or pain.
  • The opening of the cervix is gradually stretched with a series of dilators.       The thickest dilator used is about the width of a fountain pen.
  • A tube is inserted into the uterus and is attached to a suction system that will remove the fetus, placenta and membranes from the women’s uterus.
  • A follow up appointment should be made with the doctor.

Possible risks

  • Incomplete abortion
  • Pelvic infection
  • Heavy bleeding
  • Torn cervix
  • Perforated uterus
  • Blood clots in uterus

 

Dilation and Curettage Abortion

  • A local anesthetic is applied or injected into or near the cervix to prevent discomfort or pain.
  • The opening of the cervix is gradually stretched with a series of dilators
  • The thickest dilator used is about the width of a fountain pen.
  • A spoon-like instrument (curette) is used to gently scrape the walls of the uterus to remove the fetus, placenta, and membranes.
  • A follow up appointment should be made with the doctor.

Possible risks

  • Incomplete abortion requiring vacuum aspiration
  • Pelvic infection
  • Heavy bleeding
  • Torn cervix
  • Perforated uterus
  • Blood clots in uterus

METHODS USED AFTER FOURTEEN WEEKS

  • Dilation and Evacuation (D & E)
    • Sponge-like tapered pieces of absorbent material are placed into the cervix. This material becomes moist and slowly opens the cervix. It will remain in place for several hours or overnight. A second or third application of the material may be necessary.
    • Following dilation of the cervix, intravenous medications may be given to ease discomfort or pain and prevent infection.
    • After a local or general anesthesia has been administered, the fetus and placenta are removed from the uterus with medical instruments such as forceps and suction curettage. Occasionally for removal, it may be necessary to dismember the fetus.
  • Possible Risks
    • Blood clots in the uterus
    • Heavy bleeding
    • Cut or torn cervix
    • Perforation of the wall of the uterus
    • Pelvic infection
    • Incomplete abortion
    • Anesthesia-related complications

 

  • Labor Induction
    • Labor induction may require a hospital stay.
    • Medicine is placed in the cervix to soften and dilate it.
    • There are three ways to start labor early:
      • Medication is given directly into the bloodstream (vein) of the pregnant woman starting uterine contractions.
      • Medication inserted into the vagina to start uterine contractions.
      • Medication injected (instillation) directly into the amniotic sac by inserting a needle through the mother’s abdomen and into the amniotic sac (bag of waters). This stops the pregnancy and starts uterine contractions.
    • Labor and delivery of the fetus during this period are similar to the experiences of childbirth.
    • The duration of labor depends on the size of the baby and contractility of the uterus.
    • There is a small chance that a baby could live for a short period of time depending on the baby’s gestational age and health at the time of delivery.
  • Possible Risks
    • If the placenta is not completely removed during labor induction, the doctor must open the cervix and use suction curettage (removal of uterine contents by low-pressure suction).
    • Labor induction abortion carries the highest risk for problems, such as infection and heavy bleeding.
    • When medicines are used to start labor, there is a risk of rupture of the uterus.
    • As with childbirth, possible complications of labor induction include infection, heavy bleeding, stroke and high blood pressure.
    • Other medical risk may include blood clots in the uterus, heavy bleeding, cut or torn cervix, perforation of the wall of the uterus, pelvic infection, incomplete abortion, anesthesia-related complications.

 

  • Hysterotomy (similar to a Caesarean Section)
    • This method requires that the woman be admitted into a hospital.
    • A Hysterotomy may be performed if labor cannot be started by induction, or if the woman or her fetus is too sick to undergo labor.
    • A hysterotomy is the removal of the fetus by surgically cutting open the abdomen and uterus.
    • Anesthetic medication, given into the woman’s vein or back, or inhaled in to the lungs, is administered so the woman will not feel the surgery. 
  • Possible Risks
    • Complications are similar to those seen with other abdominal surgeries and administration of anesthesia
    • Sever infection (sepsis)
    • Blood clots to the heart and brain (emboli)
    • Stomach contents breathed in the lungs (aspiration pneumonia)
    • Sever bleeding (hemorrhage)
    • Injury to the urinary tract
    • Blood clots in the uterus
    • Heavy bleeding
    • Pelvic infection
    • Retention of pieces of the placenta
    • Anesthesia related complications

 

  • Dilation and Extraction
    • This method may be performed between 20 and 32 weeks gestation.
    • Sponge-like tapered pieces of absorbent material are placed into the cervix. This material becomes moist and slowly opens in the cervix. It will remain in place for one to two days. A second or third application of the material may be necessary.
    • After a local or general anesthesia has been administered, the fetus and placenta are removed from the uterus with medical instruments such as forceps, suction and curette (a sponge-like instrument). It may be necessary to dismember the fetus.
  • Possible Risks
    • Risks are similar to childbirth
    • Uterine infection
    • Heavy bleeding
    • High blood pressure
    • Rare events such as blood clot, stroke or anesthesia-related death

Minnesota Department of Health brochure, January 2009.